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Emailing Patients: Profitable? Not Everyone Agrees

The 10 Greatest Medical Inventions of the Last 50 Years

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23J U LY 2 0 1 2 • Drs.Reference T H E M AG A Z I N E


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top 10 MedicalinnovationsWe can’t deny that digitaltechnologies have com-pletely changed our world.

elements of styleThe new look of the PorscheInterior rivals a spaceship fordigital eye.

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emailing Patients:Profitable?Those who don’t want toemail with patients insist thatit’s a black hole

omega-3 Fish oilsupplementsA new review of studiesthat lasted up to 3.5 yearssuggests taking omega-3 fishoil supplements probablydoes not help older peopleward off cognitive decline,the loss in memory andthinking skills that is ahallmark of dementia.

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From infection toinflammation toCancer: scientistsoffer New CluesChronic inflammation of theliver, stomach or colon, oftenas a result of infection byviruses and bacteria, is one ofthe biggest risk factors forcancer of these organs.

Vacation of a lifetimeHow Doctor’s relax whileout of the country.

23 Drs.Reference T H E M AG A Z I N E • J U LY 2 0 1 2

MeDiCAl iNNoVAtioN

e can’t deny that digitaltechnologies have com-pletely changed our

world, and the influence ofthese modern innovations onour personal and professionallives has made a significantmark on the medical industry.Saving millions of lives around

the world, preventing the spread ofdisease, allowing for more accuratediagnosis, and enabling better pa-tient care are just some of the greatbenefits medical inventions andtechnologies have made on ourworld. But with new medical devicesbeing introduced to the healthcareindustry on a regular basis, it’s hardto keep track of all of the great in-novations that have made the mostsignificant impact on the lives ofpeople all around the globe.Here on Health Exec News, we

are committed to bringing you thebest news, updates, and studies re-lated to the healthcare industry, andhave conducted extensive researchto compile this list of the 10 GreatestMedical Inventions of the Last 50Years.Considering how quickly med-

ical technology evolves, it was noteasy to come up with only 10 med-ical innovations that have made themost impact throughout the past 5decades. However, the top 10 med-ical inventions that made our listrange from life-saving drugs, like

Highly Active Anti-retroviral Ther-apy (HAART) - which combines 3different medications into 1 for apowerful prescription that can helpextend the lives of patients withHIV/AIDS - to the artificial heartdeveloped by Dr. Robert Jarvik,which replaces one of the most vitalorgans in the human body and hasbeen saving lives since the early1980’s. Even the “classic” medicaltesting devices have their place onour list; in fact, our top pick for MRIand CT technologies reflects whatan incredible impact these two tech-nologies have made on the medicalindustry since their inception in thelate 1970’s.We can’t deny that digital tech-

nologies have completely changedour lives, and the influence of thesemodern innovations on our personaland professional lives has made asignificant mark on the medical in-dustry. Many physicians and care-givers are now dedicated to usingmobile medical technology, liketablets, smart phones, and othertelecommunications devices to im-prove patient care in less time andwithout having to worry about geo-graphical boundaries. Other digitalapplications, like in the newly-cre-ated Active Bionic Prosthesis (num-ber 10 on our list), use moderntechnologies like microprocessorsand Bluetooth to replicate naturalfunctions in muscles and tendons.Patients using this medical invention

can make adjustments to their“wearable robotics” right throughtheir smart phones. Now that’s mod-ern innovation!Each of the 10 medical inven-

tions acknowledged in our list is re-sponsible for saving or improvingthe lives of patients around theworld and have made their mark inmedical history.Here is an in-depth guide to the

Health Exec News list of the Top 10Best Medical Inventions of the Last50 Years:

10 Active Bionic Prosthesis (Wear-able Robotic Devices). Prostheticlimbs are no longer non-functioningitems. Technology now allows us toreplicate the action of a person’s

W

The 10 Greatest Medical Inventions of the Last 50 Years

Above: Highly active anti-retrovival therapy (HAART).

continued...



tendons and muscles to mimic natu-ral body motion. Battery-poweredmotors, microprocessors, and Blue-tooth technology allow a person toadjust settings easily with a smartphone to ensure natural and consis-tent motion.

9 Health IT (especially mobile/wireless devices). Physicians nolonger have to dig through piles of

books and case studies to find theinformation they need to help a pa-tient. Now they can look up infor-mation, access patient records, andview digital medical information inseconds, no mater where they are lo-cated. In fact, nearly 82% of physi-cians are projected to use smartphones in 2012.

8 Molecular Breast Imaging (MBI)This technology is making an impactin the fight against breast cancer.While mammography has been oneof the leading methods of detection

for breast cancer for years, it has notbeen effective in detecting tumors indense tissue. MBI is a safe and morepowerful scan which serves as an en-couraging alternative to mammog-raphy.

7 Modern Telehealth Telehealth ishelping to significantly reduce thenumber of ER visits and hospitaliza-tions around the world. By combin-ing powerful telecommunicationstechnology and healthcare advance-ments, patients and doctors can con-nect like never before without

Prosthetic limbs are no longer non-functioning items.


consideration for geographicalboundaries. Telehealth supportsmore efficient diagnosis, treatment,and care management for patientsby enabling doctors to share and ac-cess diagnostic images, video, andpatient data.

6 Highly active anti-retrovival ther-apy (HAART).This medication hasbeen in development stages foryears but has proven to be a power-ful symptom reliever for patientssuffering from HIV/AIDS. By usingthree medications to create onepowerful combination, HAART hasbeen clearly shown to delay progres-sion to AIDS and prolong the life ofinfected patients anywhere from 4to 12 years.

5 Functional Magnetic ResonanceImaging (fMRI). By non-invasivelyrecording brain signals without therisks of radiation, this new techniquetracks blood flow in the brain tomonitor areas of activity. It can beused to monitor the growth of braintumors, determine how well thebrain is functioning after a stroke ordiagnosis of Alzheimer's disease,

and find out where in the brainseizures are originating.

4 Minimally invasive robotic surger-ies. Surgeries aided by robots werefirst introduced in the late 1980’swith laproscopic procedures andhave been advancing ever since.Today’s “da Vinci” robot has treatedmore than 775,000 patients, and

Physicians no longer have to dig through piles of books and case studies to find information.

23 Drs.Reference T H E M AG A Z I N E • J U LY 2 0 1 2 23J U LY 2 0 1 2 • Drs.Reference T H E M AG A Z I N E


Instead of leaving patients with ex-tensive scarring, these minimally-in-vasive surgeries leave only a fewsmall marks on the body and allow for greater accuracy during surgeryand less post-operation recoverytime.

3 Laser Surgeries were first used tocorrect vision, but today their usespans across many medical andcosmetic procedures. Whether usedfor corrective eye surgeries, cos-metic dermatology, or the removalof precancerous lesions, Light Am-

plification by Stimulated Emissionof Radiation (LASER) allows foraccurate focus on very small areas ofthe body.

2 The Artifical Heart. Robert Jarvik,MD is widely known as the inventorof the first successful permanentartificial heart, the Jarvik 7, first

implanted in 1982. Since that time,this medical invention has helpedsave thousands of lives all over theworld, as heart disease is the numberone cause of death in the UnitedStates and many other countries,leading cardiologists to continually search for ways to improve hearthealth. Currently, temporary and

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permanent artificial hearts are beingused to help patients stay healthywhile awaiting a heart transplant orto nurse their current hearts back tohealth.

1 Magnetic Resonance Imaging(MRI) and Computed Tomography(CT). These two medical technolo-gies seem like standard procedurestoday, hinting at their significantimpact on healthcare. The firstwhole-body MRI scanner was con-structed 1977 by Dr. Damadian,which he dubbed the "Indomitable”

and CT scans were developed by SirGodfrey Hounsfield and Dr. AlanCormack, for which they wereawarded the Nobel Prize in 1979. Bycombining a series of images, or“slices”, taken from many different

angles, doctors can examine detailedparts of the body individually orproduce a 3-D image of that area,allowing them to quickly and accu-rately identify internal trauma or ir-regularities.




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letteRs to the eDitoR

ore practices are talkingabout employing these kindsof health practitioners. Here

are some things to consider.

By VICTORIA STAGG ELLIOTT, amednews staff. Posted Jan. 10, 2011.

If you are considering employing anurse practitioner or a physician as-sistant, the success of the hire likelyrests on one simple question: Whatdo you want the person to do?

That may be harder to answer thanit seems. "Simply adding somebodyand saying they are going toimprove your care or improve yourproductivity is almost alwaysdoomed to failure," said familyphysician Daniel Mingle, MD, chiefphysician executive and an owner ofMaine MSO in Portland. "You needto be clear on how to incorporatethat person in the practice and reallyunderstand how you want them toperform."

Experts say the first step is to deter-mine whether a nurse practitioneror physician assistant would suit thepractice's needs. State regulations,which differ across the country, willhelp with that decision.

"First and foremost, be familiar withthe state laws," said Marsha Siegel,a nurse practitioner in Cheyenne,Wyo., and president of the board ofthe American College of NursePractitioners.

For example, nurse practitioners canprescribe in all 50 states but can pre-scribe controlled substances in only47. Physician assistants are generallysupervised by a doctor. Nurse prac-titioners are more likely to work incollaboration with a physician andcan practice independently in 16states.

Some states require a physician toaudit a percentage of the charts.Others require a written supervisionor collaboration plan either on filewith a state agency or held at thepractice. Nurse practitioners areusually regulated by the state boardof nursing and physician assistantsby the state's medical board.Several medical societies have advo-

cated against the expansion of thescope of practice of physician assis-tants and nurse practitioners. TheAmerican Medical Association,along with the American Osteo-pathic Assn., the American Acad-emy of Family Physicians and theAmerican Academy of Pediatricspublished a letter in the Dec. 15,2010, issue of The New EnglandJournal of Medicine advocating aphysician-led approach to care,"with each member of the teamplaying the role he or she has beeneducated and trained to play."

Nurse practitioners can prescribe inall 50 states and can prescribe con-trolled substances in 47.

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Bringing PA’s and NP’s on board:What to do if you're hiring


[Illustration by Andrew DeGraff / www.andrewdegraff.com]


State penalties for wrongly settingup a physician assistant or nursepractitioner at a practice vary widelybut can include fines and criminalcharges.

"You have to understand what thescope of practice is and what super-vision and collaboration means,"said Ron L. Nelson, a physician as-sistant and CEO and president ofHealth Services Associates, a prac-tice management consulting firm inFremont, Mich. "And it's importantto have systems in your practice tomake sure that adequate collabora-tion and supervision occur. A physi-cian is ultimately responsible for thequality of care provided by these in-dividuals."

Practices also need to think aboutthe tasks required. Physician assis-tants tend to carry out more proce-dures. Nurse practitioners are morelikely to provide services related toevaluation and management.

"If practices want the person to dolots of technical procedures like

bone marrow aspirations, they oftenhire physician assistants," said Car-olyn Buppert, ANP, a nurse practi-tioner and an attorney in Bethesda,Md. "If the job entails more visitsfor evaluation and management,then it is more likely to be a nursepractitioner."

Defining the parameters of the jobcan lead to the biggest mistakes.Those who work for organizationsrepresenting these health careproviders say nurse practitionersand physician assistants quickly willleave practices that do not use theirfull set of skills, or expect them to gowell beyond them.

"The main reasons physician assis-tants leave is not because ofmoney," said Ellen Rathfon, seniordirector of professional advocacy atthe American Academy of PhysicianAssistants. "It's because of the typeof relationship with the supervisingphysician and the relationship withthe practice, or a lack of opportuni-ties to grow."

Nurse practitioners can practice in-dependently in 16 states.

For example, Taynin Kopanos, direc-tor of health policy/state govern-ment affairs at the AmericanAcademy of Nurse Practitioners, re-cently spoke to nurse practitionersthinking about leaving medical prac-tices that had recently hired them.One was a nurse practitioner whowas being asked to manage chil-dren's health care needs, which wasoutside her base of knowledge. Theother was being used by the physi-cian primarily to take notes andthen educate patients on varioushealth matters.

"That was really a mismatch be-tween her skills and the role that thepractice has created," Kopanos said."In that case, the practice doesn'tneed an advanced practitioner."

Personal preference also can play asignificant role. For example, Cyn-thia Coté, MD, a family physicianwho also performs noninvasive cos-metic procedures at her practice inMaple Valley, Wash., recently hireda physician assistant. She chose thistype of health practitioner over annurse practitioner because she hadmore experience with PAs.

When the type of medical practi-tioner is identified, a job descriptionshould be formalized. Will there beovertime? Will the nurse practi-tioner or physician assistant be oncall? Does a practice want NPs orPAs to have their own panel of pa-tients, or will they be shared with thephysician? Will they handle only ur-gent care, chronic disease manage-ment or both? Will they provideservices that are separately billableor those that allow physicians to seemore patients and increase collec-tions? What level of supervision orcollaboration does a physician feel




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comfortable with, and what is re-quired by law? Does a physicianwant to review more charts, at leastinitially, than the number mandatedby regulation?

"You have to ask how independentof a practice are you going to de-velop for our nurse practitionersand physician assistants," said KenLester, a network executive withHalley Consulting in Westerville,Ohio.

Reimbursement and salary

The next step is to talk to insurersabout how this health care practi-tioner needs to be credentialed andhow services will be paid. This cantake months. Some insurers will re-imburse directly for services pro-vided by a nurse practitioner orphysician assistant. Others will re-quire that they be linked directly toa credentialed physician.

"You need to understand how tohandle the billing and the coding."said Kenneth Hertz, a principal in

the Medical Group ManagementAssn. Health Care ConsultingGroup. "You need to have a clearappreciation for what they can andcannot do."

Medical practices also need to de-termine a salary and a compensationstructure.

Most nurse practitioners and physi-cian assistants are on a straightsalary, although compensation is in-creasingly linked to productivity andquality much like a growing numberof physicians. Some are paid on apercentage of receipts or charges ora per-visit fee.

Professional organizations and med-ical societies can be a source of in-formation on salary ranges andtypical benefits for a practice's loca-tion and specialty and the job's du-ties.

Recruiters say, however, that med-ical practices, even small ones, com-peting with large hospital systemsmay not necessarily have to match

or beat salary and benefits, whichtend to be higher at larger institu-tions. The medical practice settingmay have other advantages, such asset hours or no night work. Somenurse practitioners and physician as-sistants may be looking for a smallpractice.

"Most don't care about a few thou-sand dollars," said Carlos O. Her-nandez, MD, an internist andpresident of WellMed MedicalGroup in San Antonio. "What theyare going to look for is fit."

After taking these steps, it's time toget the word out that a job is avail-able.

Experts suggest contacting a localtraining program to get the positionlisted on virtual as well as cork-and-wood bulletin boards. Societies rep-resenting these health carepractitioners also have job listings,which may be free.

License, background checks

Background checks are importantfor promising applicants, including alicense check with the appropriatestate board. Applicants should beasked during interviews whetherthey are under investigation, beingaudited by Medicare or part ofpending liability litigation. Askabout any convictions.

Answering "yes" to any of thesequestions does not automaticallymean the person should not behired, but the issue should be furtherexplored. For example, the applicantmay be part of a long list of physi-cians, nurse practitioners and physi-cian assistants who provided care atsome point to a patient who hasfiled a lawsuit. An audit does notnecessarily mean anything is wrong.In addition, an applicant may have




learned something from the experi-ence that could be valuable to thepractice.

"You want to know the specifics,"Buppert said. "There's nothing neg-ative about being audited, but youwant to know how it worked out."

Experts say the most importantissue is whether the personality andstyle of a physician assistant ornurse practitioner fits with the prac-tice and the physician.

"You can have the best-educatedphysician assistant or nurse practi-tioner, but if they don't fit into thegroup, it is not going to work," Dr.Hernandez said. "They have to havean ability to fit into our specific cul-ture."

Number of NPs, PAs up sharplyThese figures show how the numberof RNs educated as nurse practition-ers and physician assistants in clini-cal practice has grown over theyears.

Sources: American Academy of Physician As-sistants, Health Resources and Services Ad-ministration

Improper titles may offend profes-sionals, confuse patients

Nurse practitioners and physicianassistants are frequently calledphysician extenders, midlevel prac-titioners, limited license providers,

nonphysician providers and alliedhealth providers in usual parlanceand medical society policies. The de-scriptors make these health carepractitioners bristle. Using themwhen trying to recruit, rather thanspecifying "nurse practitioner" or"physician assistant," may turnprospective hires off rather thanpersuade the best and brightest tosend in their resumes.

"I believe we should be called by theprofessional credentials we haveand not boxed into some 'midlevel'label," said Ron L. Nelson, CEOand president of Health Services As-sociates, a practice managementconsulting firm in Fremont, Mich.

Other preferred terms include inde-pendently licensed providers, pri-mary care providers, health careprofessionals and clinicians.

People who work on this issue saythe frowned-upon terms confuse pa-tients and make it seem as if the careprovided is of lower quality thanthat delivered by physicians. But the

conflict over terminology also hintsat the long-simmering battles aboutscope of practice and the role theprofessionals fill at a practice. Peo-ple who hire NPs and PAs say non-physicians who feel their work isequivalent to that of a physician cansometimes cause discord.

"Some have real issues with havingphysician supervision, and thatsometimes can be a stumblingblock," said Carlos O. Hernandez,MD, an internist and president ofWellMed Medical Group in San An-tonio.

Experts advise having clear bound-aries around what a PA or NP does,and what duties and decisions be-long to the physician. This should bediscussed during the interviewprocess to help avoid problems.



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PRoFile seCtioN

By APRil CAshiN-GARButt, BA hoNs (CANtAB)

Please could you give a briefoutline of robotic spine sur-gery and its recent history?

Robotic spine surgery is verynew, less than 10 years old. There areonly 10 hospitals in the US offeringit and we are the second hospital inCalifornia to offer this technology.We are one of the sites helping

Mazor to develop the technology forfurther uses.

2. How was the robotic technologydeveloped?The technology was developed in

Israel. It is based on a CT scan.They developed a computer soft-

ware program that takes the pa-tient’s pre-emptive CT scan andhelps register that with two X-raystaken in the operating room.The computer program can go

back and forth between the images.It uses this to allow the robot to nav-igate up and down the spine with ex-treme accuracy.

3. What are the benefits of Mazor’sRenaissance guidance systemThe Mazor Renaissance guid-

ance system works by taking anoblique X-ray in the operatingroom. This is a miniscule amount ofradiation in comparison to what weused to do in the past.Previously, we would take six or

seven X-rays for each screw to makesure that it was not too close to a

blood vessel, the spinal cord or tothe nerve root.Now we take two X-rays at the

beginning of the surgery and thencan place multiple screws during theoperation without the need to takeany more X-rays.

4. So the technology reduces theamount of radiation experienced bythe patient?Yes, but the technology is also of

benefit to the whole team providingthe healthcare. This is because theentire team in the operating roomexperiences less radiation.The operating team in robotic

spine surgery typically consists oftwo surgeons; the scrub nurse, whohands us instruments; the circulatingnurse, who gets things that are not inthe room; the anesthesiologist and a

fourth doctor who monitors all thenerves during the surgery.Prior to the surgery, the doctor

responsible for monitoring thenerves places monitors on the pa-tient’s body and throughout the sur-gery makes sure the nerves arestable and makes sure the screws arenot placed in a position which willaffect the nerves.

5. It was recently announced thatyou are using an enhancement tothe Mazor Renaissance guidancesystem, could you tell us a little bitabout this?In the enhanced system we use

the same technology to enable us toget an intraoperative 3D reconstruc-tion of the spine.This is the equivalent of getting a

post-operative CT scan. Now we canget this without the radiation of aCT scan, which is high.The beauty of the technology is

that at the end of the surgery, the X-ray machine can be brought back inand the 3D reconstruction createdwithout having to take the patient tothe CT scanning room. The recon-struction can be done within the op-erating room.Then we can continue with the

surgery if we need to.

6. So what is the typical procedureof robotic spine surgery?Typically once we have done the

instrumentation portion of the sur-

1.

Interview with Dr Moazzaz onadvances in robotic spine surgery



gery, we bring the X-ray machine inand do the 3D reconstruction.Then the X-ray machine leaves

the room.We then usually need to do a de-

compression then do the fusion partof the surgery.

7. What kind of patients do you usethe technology on?The majority of my patients are

elderly. My areas of expertise areminimally invasive spine surgeryand spinal deformity.The technology is really useful

for treating the elderly or those withosteoporotic bones.This is because when you are

doing surgery on patients with os-teoporosis, if you are a little bit offwith the placement of the screw andyou need to reorientate it two orthree times, you quickly find thatyou have nothing left to put thescrew in to.Thus, with osteoporotic patients

you really need to get the screw po-sitioning right on your first attempt.The Mazor technology allows

you to do so and get it perfect. Thismeans that you don’t have to makemultiple passes thought the bonewhich ends up weakening the boneand the construct. This essentiallyleads to failure due to lack of fusion.The technology is also perfect for

revision surgery and surgery onthose with spinal deformity.This is because the surgeon can

still place the screws in positioneven though he doesn’t have thenormal landmarks to rely on. In-stead the surgeon can rely on thepre-emptive CT scan.

8. Are there any other benefits tothe technology?The technology also allows the

surgeon to make much smaller inci-sions and do minimally invasive sur-gery, as we don’t have to rely on oureyes. We can rely on the technologyto put the screws in the right spot.

The technology means that thepatients heal faster and can leavethe hospital sooner. They also tendto need less post-operative nar-cotics.They are up walking the same

day of the surgery, and it is generallya much more pleasant experiencefor them.The smaller incision that we are

able to make means that there is lessblood loss, less chance of infectionand less anesthesia complications.

This is because we don’t need tokeep the patients anesthetised forlong periods of time anymore.

9. Overall how revolutionary do youthink this technology is?I think the technology is a game-

changer.Previously screws would be put

in the wrong place and cause injuryto the nerves. This was not recog-nised until after the surgery whenthe patient would wake up in pain.




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Now we can get the screw position-ing right during the surgery.I ask for the technology on every

one of my cases now, as I can go tosleep at night knowing the screwsare in the perfect place and that thepatient is going to wake up and dovery well.

10. How do you think the future ofrobotic spine surgery will progress?There is certainly a learning

curve with this technology, althoughI wouldn’t say it is a very steeplearning curve. We are still new tothis technology and we are gettingfaster and faster with every case wedo.Right now the technology is

being used to put screws in thoracicand lumbar spine and we havestarted to put screws in the pelvis: sofar we have done one case here.As the technology evolves I see

that they’ll be putting screws in thecervical spine with the same tech-

nology as well.Also, in addition to placing

screws, I think we will be able toplace cages or interbody devices inthe spine with this technology.One day all types of implants will

be able to be put in using the Mazortechnology.

About Dr. Payam Moazzaz

Dr. Moazzaz specializes in mini-mally invasive spine surgery andcomplex spinal deformity of the cer-vical, thoracic, and lumbar spine.Dr. Moazzaz is passionate about of-fering his patients surgery throughthe least invasive approach possibleto achieve excellent patient out-comes and quicker recovery times.From nerve decompression and so-phisticated fusion procedures to ad-




vanced motion-sparing and mini-mally invasive techniques, Dr.Moazzaz is an expert in the newestadvances in spinal surgery.Dr. Moazzaz completed his sur-

gical internship and orthopaedicsurgery residency at the prestigiousUniversity of California, Los Ange-les Medical Center, consistentlyranked as the #1 hospital in thewestern United States. He then re-turned to his hometown of SanDiego and completed a fellowship inspine surgery with an emphasis onminimally invasive surgery and com-plex deformity surgery.Dr. Moazzaz is committed to re-

search and education and advancingthe field of spinal surgery. Dr. Moaz-zaz has published several bookchapters and peer-reviewed publica-tions on orthopaedic and spinal sur-gery and has received numerousresearch awards and grants. He haspresented his research at overtwenty national and international

meetings and is a key investigator inmany ongoing clinical studies.Dr. Moazzaz is a native of the

San Diego North County andstrongly feels that service and givingback to the less-fortunate are impor-tant aspects of his medical practice.He has volunteered at local SanDiego hospitals and traveled toMexico to perform medical missiontrips. When not in the operatingroom or taking care of his patientsin the clinic, Dr. Moazzaz enjoysspending time with his wifeAmanda, working out, playing thepiano, and traveling.

About Orthopaedic Specialists ofNorth CountyOrthopaedic Specialists of North

County (OSNC), was founded inOceanside in 1965 and incorporatedin 1973. Over the years, they havetreated multi- generations of fami-lies, including parents, grandparentsand great-grand-parents for their or-thopaedic injuries and ailments.Their 13 board-certified physi-

cians care for accident, sports - orwork-related injuries, replacing totaljoints, or relieving chronic or acutepain. They give patients morelifestyle choices by offering the lat-est procedures, to help them stay ac-tive. For the convenience of theirpatients OSNC also offers servicessuch as imaging, urgent care, andphysical therapy to help patients re-cover; regain body strength quickerwith less locations to visit.

For more information on their doctorsand services please visit: www.orthonorthcounty.com




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tRAVel/leisuRe

he word conjures up imagesof pure pleasure, indulgencein the finest of everything.

When you apply the word to hotels,you immediately envision impres-sive décor, impeccable service, anda myriad of accoutrements andamenities to make your stay beyondmemorable. Those attributes, andmany more, are what make thesehotels the ten finest luxury hotels inthe world.

Avenida Palace – Lisbon, PortugalAt this luxury hotel, you stay in thecity’s only palace. Built in 1892, thismagnificence hotel features elegantrooms with marble bathrooms, aJacuzzi and spectacular view ofSt. Jorge Castle and Marques dePombal Square are the epitome ofluxury. Located in Restauradores

Square, you’re but a few momentsaway from the heart of the city’scultural district. The Avenida Palaceis truly a place fit for royalty.

Steigenberger Frankfurter Hof –Frankfurt, Germany

The Steigenberger Frankfurter Hofhotel in Frankfurt is ranked amongthe top 100 hotels in the world. The

Steigenberger Frankfurter Hof is lo-cated in the city centre, momentsaway from Frankfurt’s shoppingareas and cultural treasures. Thehotel is considered to be a livingmonument to the five-star hotel in-dustry and is luxuriously furnishedand fitted with modern communica-tion and entertainment facilities.

Fujairah Rotana Resort and Spa –Fujairah, United Arab EmiratesThe setting is spectacular: vibrantgardens surrounded by dazzling wa-terfalls and pools, and white sandbeaches that seem to go on for days.Each room has a private terrace

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rants, two ballrooms, and all on five-star property that is as close as youcan get to the Summer Palace. Eachroom has an East-West stylistic fu-sion that is a haven in this busy city,and the luxury suites are unforget-table. The Marco Polo is also a per-fect choice if you’re headed to theOlympics in 2008; the hotel is just ashort walk from the Olympic MainStadium.

t

Top Ten Best Luxury Hotels



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Grace Hotel Sydney – Sydney,AustraliaYou have heard the rumors that theGrace Hotel has the most comfort-able beds in Sydney, and after youspend a night on the feather pillowsunder the feather comforter, you’llknow why. An art deco luxury hotelbuilt in 1930; this hotel was restoredwith original features, so you’ll walkdown wide hallways over marblefloors under pressed-metal ceilingsalongside masterful ironwork. It’s aneasy walk to the Darling Harbourand King St. Wharf, not to mentionthe fabulous shopping at the QueenVictoria Building. Say, “yes” to a

stay at the Grace, and you maynever want to go home!

Warwick New York Hotel –New York City, United StatesWhen you arrive at this historiclandmark built in 1927 by WilliamRandolph Hearst for his lover, youwill be greeted with chilled cham-pagne and chocolates. The spaciousrooms offer marble bathrooms andtwenty-four hour room service, and

the restaurant features more thanfifty stunning murals. Whether youwant to go to Central Park, Fifth andMadison Avenue for shopping,

Radio City Music Hall, TimesSquare or Rockefeller Center, youdon’t have far to walk. That CaryGrant lived here for twelve yearssays it all.

Al Manshar Rotana Hotel – Kuwait,KuwaitDesigned to be in keeping with tra-ditional architecture, this modernnineteen-floor, five-star luxury hotelhas a pool on the roof that allowsyou to swim amid a scintillating viewof the Kuwait Harbor and radiantGulf. Or you can relax in the out-door Jacuzzi, the sauna or steamroom, or while you’re getting an in-




credible massage. World class shop-ping is right outside the door, andeach of the two hundred luxuriousrooms is fully equipped with a kitch-enette. There is also a poolside snackbar and an elegant in-house restau-rant that provides incomparable cui-sine all through the day and night.No matter what you want, this placehas it.

Royal Windsor Grand Palace –Brussels, BelgiumBecause this hotel offers a selectionof rooms individually designed byfamous fashion designers, your

choices are incredible. Imaginesleeping in one room with frescoespainted by an Italian artist on thewalls and floors of ceruse wood and

Roman stone, or lapping up the lux-ury in another room that has a sofacovered with fuchsia velvet and abed covered with a high couturepatchwork quilt. The best location intown, this luxury hotel is one streetaway from the Grand Palace and aheartbeat away from the Sablon An-tique Square. It’s not called a palacefor nothing.

Silken Puerta America – Madrid,SpainEighteen world famous architectsand designers combined efforts tocreate this dream luxury hotel. Eachof the twelve floors is truly unique,and exquisite attention has beenpaid to the smallest detail in everyroom. Gracefully situated on aquiet, residential street, it is only afive minute-walk to the world fa-

mous Avenida de America and itsaccess to all the city’s best sites. Thehotel also sits just a short walk awayfrom the exclusive shops of SerranoStreet.

Grand Rotana Resort and Spa –Sharm El Sheikh, Egypt`While staying in this luxury hotel bythe sea, you can snorkel, windsurf,ride horses or camels, take a desert

safari or visit the ancient sites; youeven have your own private beach.The hotel boasts seven restaurantsand bars including Ramses for localcuisine. Swim on the private beach,or the lagoon-style pool that is thesize of three Olympic pools; there’seven a kids private club and pool.It’s little mystery why we think thisthe best luxury hotel in the world.




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By APRil CAshiN-GAR-

he old saying goes thatwatching too much TV willmake your eyes go square.

Nowadays, we seem to spend mostof our time looking at screens: be ita computer screen at work, a mobilephone screen to make a call or a TVscreen to relax. But how bad is look-ing at screens for our eyes? Is therereally any truth behind the oldsaying?According to Dr Blakeney, an

optometric adviser to the College ofOptometrists, computers will notpermanently damage the eyes; how-ever, they can cause strain or exac-erbate existing eye conditions. (1)

What problems do looking at com-puter screens cause?People who look at computers

frequently, (in particular those thatlook at a computer for more thanthree hours a day), (2) may experi-ence symptoms such as:

Eye discomfortHeadachesItchy eyesDry or watering eyesBurning sensationsChanges in color perceptionBlurred visionDifficulty focussing (1, 2, 3)

EyestrainEyestrain is a type of repetitive

strain injury (RSI) that is caused byinsufficient rest periods, incorrectworking conditions and so forth. (2, 4)

There are many causes of eye-

strain. One of these is glare.There are two types of glare,

direct and indirect. Direct glare iswhere light shines directly in youreyes; whereas indirect glare iscaused by light reflecting offsurfaces into your eyes. (3)Glare often results from com-

puter screens being too dark or toobright. (2, 5)Glare leads to eye muscle fa-

tigue, for the eyes have to struggle tomake out the images on the screen.(2)

Another major cause of eye-strain is the position of the com-puter screen.Naturally, the eyes are positioned

so that they look straight ahead andslightly down.If the eyes have to look in a dif-

ferent direction, the muscles have to

continually work to hold this posi-tion.Thus, if your computer monitor is

positioned incorrectly, the eye mus-cles must constantly work to holdthe eyes in the correct position toview the monitor. (2)In order to prevent the eyes be-

coming strained in this way, the topof your computer screen should beno higher than eye level. (3)

Dry eye syndromeAccording to the NHS, using

your computer correctly can alsohelp to prevent dry eye syndrome.Dry eye syndrome is a condition

in which the eyes become inflameddue to a lack of tears. This lack oftears is commonly due to a blockageof the oil secreting glands in theeyes.

t

Does looking at a computerdamage your eyes?



Although this condition causesdiscomfort, it does not usually affectvision. (6)

Ways to minimise damage to youreyes caused by computer screensThere are several ways you can

minimise the potential damage toyour eyes caused by looking at com-puter screens.Firstly, it is important to set up

your computer screen so that it is inthe correct position in relation toyour eyes.As previously mentioned, the top

of the screen should be in line withyour eye level. In addition, thescreen should be placed approxi-mately 18-30 inches from you.The screen should also be tilted

slightly back – between 10 to 15 de-grees depending on the person’sparticular preference. This is so thatyou do not receive glare from lightsin the ceiling. (3, 7)Glare can also be avoided by

placing blinds over nearby windows,or using a glare screen. (2, 5)In addition to adjusting the posi-

tion of your screen, you can also

minimise eye problems by simplyblinking more frequently.Many people don’t realise that

they actually blink less when theylook at a screen. (2)Blinking is important, however,

as it washes your eyes in their natu-rally therapeutic fluids. (5)It is also important to take

breaks from looking at your screen.One easy way to remember this is tothink of 20-20-20. This reminds youthat every 20 minutes you should tryto look at something 20 feet awayfor a minimum of 20 seconds. (5)It is also recommended to take

breaks from your screen altogether,in particular every 2 hours. (2)

Can looking at screens improveeyesight?Despite the potential eye prob-

lems caused by looking at a screentoo frequently, research carried outin the US has actually found thatsome screen viewing can be of ben-efit to the eyes.Specifically, they found that play-

ing video games can improve vision.

This is because playing videogames gives the users chance to im-prove their contrast sensitivity. (8)Contrast sensitivity refers to how

faded an object can be before it isimpossible to differentiate it fromthe same field of view. It is some-thing that is affected by ageing. (8, 9)Contrast sensitivity is particu-

larly important for activities such asdriving in poor visibility, like in fogor at night. (8)

Overall does looking at computersdamage your eyes?Overall it seems that although

looking at a computer may notcause permanent eye damage, it cancause some irritating problems, suchas eye strain and dry eyes.It is also important to remember,

that there are many other potentialproblems associated with sittingdown and staring at a computer forlong periods of times, such as deepvein thrombosis (DVT).



Sources

1. http://www.nhs.uk/livewell/eyehealth/pages/eye

safety.aspx

2. http://www.princeton.edu/uhs/healthy-living/hot-

topics/ergonomics/

3. http://www.une.edu.au/hrs/handbook/04/4.12.pdf

4. http://staffcentral.brighton.ac.uk/xpedio/groups/

public/documents/workshop_docs_is/doc002851.pdf

5. http://www.wellness.uci.edu/toolkit/march/

screenstrain.pdf

6. http://www.nhs.uk/conditions/dry-eye-

syndrome/Pages/Introduction.aspx

7. http://publichealth.lacounty.gov/ivpp/pdf_injury_

factsheets/WorkStationSetUp_Jan2012.pdf

8. http://news.bbc.co.uk/1/hi/health/7967381.stm

9. http://www.ndt-ed.org/EducationResources/

CommunityCollege/PenetrantTest/Introduction/

contrastsensitivity.htm

10. http://news.bbc.co.uk/1/hi/england/bristol/

4753833.stm

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sPeCiAl seCtioN

here are plenty of greatluxury sedans of all shapesand sizes, but here are the

ones that shine in 2012. Althoughwe aimed for a Top 10 list, wecouldn’t decide which one ofthese beauties to cut, so in the im-mortal words of the faux bandSpinal Tap, “We’ve got 11.”

Here’s the list, in alphabeticalorder:

Audi A6 – Beautifully updatedfor 2012, the midsize sedan hasbeen overshadowed by its flashiersibling, the A7.

Bentley Continental Flying Spur– Splendid British luxury pow-

ered by a VW-sourced W12 en-gine with 552 horsepower, andpriced at $181,000.

BMW 5-Series – Still the bench-mark midsize luxury sedan fordriving enthusiasts, highlighted byits high-performance M5 version.

Cadillac CTS-V – In either sedan,coupe or wagon form, the superCaddy comes with a 556-horse-power supercharged V8, Mag-netic Ride Control and Brembodisc brakes to compete with theworld’s best luxury/performancecars.

t

Top 10 Luxury Cars of 2012



Infiniti M class – These choicesedans come in a range of types,from the base M35 to the high-performance M56 and the cleanM35h hybrid.

Jaguar XF – Stylish and refined,

the new model drives like a thor-oughbred, with the performance-tuned XFR boasting a 510-horsepower supercharged V8.

Lexus LS460 – The lush full-sizesedan provides the exemplarycomfort and smooth-riding char-

acteristics favored by many lux-ury-car buyers. Also available asa pricey hybrid.

Lincoln MKS – The flagshipsedan can be boosted with anEcoBoost V6 that efficiently gen-

erates 355 horsepower in the full-size luxury craft.

Maserati Quattroporte – A sexyItalian body and finely crafted in-terior make the Quattroporte(Italian for four-door) a fittingsedan model for the storied per-formance brand.

Mercedes-Benz E-Class – TheGerman automaker’s most-popu-lar model is better than ever withsharpened styling and a wide



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choice of variations including thehigh-performance AMG versionand the impressive Bluetec diesel.

Rolls-Royce Ghost – Here’s thereal deal, the top of the luxury-carheap and the latest craft to weara Flying Lady on its nose, in ei-ther base or extended-wheelbasemodel, priced from $250,000 to$290,000.



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